Short, badly paid and late: home care in England and Wales

CM2000 Care Management, one of the call monitoring systems used by councils (www.cm2000.co.uk)

– One in five home care visits last for less than 15 minutes in some areas, based on results from Freedom of Information disclosures from 31 councils

– 7% of visits are shorter than 15 minutes

– One in ten visits start over half an hour late

– Many councils use electronic call monitoring systems to cut costs, not monitor care

Last year Corporate Watch was contacted by the daughter of a woman who was being cared for in her home by a private care company contracted by her local council. She had been repeatedly left without adequate care due to cancelled or late visits, or ones that were cut short early as the care worker had to go to another appointment. Some of her care visits lasted just three or four minutes.

In the course of our investigations into care companies over the last two years, care workers have regularly complained that they cannot get to visits on time, or stay as long as they need, because the rotas they are given by the companies they work for cram visits in without due regard to the standard of care. This is a common finding in reports into home care by regulators, unions and NGOs, while many councils continue to contract 15 minute-long visits, against official guidance that says home care visits should be at least half an hour.¹.²

Read more: The Home Care Business – biggest care companies pay out millions to owners while quality of care suffers

To find out how widespread short and late visits are, the daughter suggested we could use records from the councils’ ‘Electronic Call Monitoring’ (ECM) systems. The systems log when a care worker arrives at a visit and when they leave, often by the worker making a phone call to a dummy number.

The information collected can be used to see whether visits are starting on time and how long they are lasting. The system can also be used to determine care workers’ pay, as many are only paid for the duration of their visits and not the travel time in between (see below).

Read more: Major homecare company paying staff below minimum wage

Corporate Watch submitted Freedom of Information requests to each of the 175 councils responsible for home care provision in England and Wales. We asked for records from their ECM systems, detailing late visits and those lasting even less than 15 minutes over a three month period between March and May 2016.³

In total, 31 councils disclosed records of late and short visits over more than six million home care visits.* The results give an insight into the extent to which elderly and disabled people are being failed by the underfunded, privatized home care service.

If you have information about a company that you’d like to share with Corporate Watch, email us at contact[at]corporatewatch.org or call 02074260005.

Short visits

Home care visits are often too short to provide people with the care they need. In April 2015 ministers signed up to new statutory guidance from the National Institute for Health and Care Excellence, after it concluded that appropriate and compassionate home care could not be provided in under 30 minutes. But earlier this year an investigation found that one in five councils were still commissioning 15 minute care visits.⁴

And these new ECM figures show that many people have to cope with visits that are even shorter than that.

Of the councils we contacted, 24 disclosed information relating to short visits. In the three month period from March to May 2016, these councils recorded 5.6m visits with their ECM systems.

They told us that almost 400,000, or 7%, of visits in the three month period lasted less than 15 minutes.

Another 135,000 were less than ten minutes long, and 53,000 were less than five minutes.⁵

How likely you are to receive a short visit depends on where you live. For example, around 20% of visits in Oxfordshire, Knowsley and Luton lasted less than fifteen minutes, with 14% of visits in the latter lasting less than ten minutes and 8% lasting less than five minutes. In areas such as Bracknell and Herefordshire meanwhile this figure was only 1%.

**Don’t record numbers of visits less than ten or five minutes late

We asked all the councils with above average late figures to comment on the results. Councils pointed out to us that some of these visits may have been intended to be shorter, so-called ‘welfare’ visits, which are, in the words of East Sussex county council, “for simple tasks that can be completed within the allocated time such as welfare checks or administering medication”. But it was not clear from any of the councils’ responses exactly what proportion of their shortened visits were supposed to be fifteen minute long welfare visits, not personal care visits.

Others said calls may be cut short at the request of the service user, or for a variety of reasons, including: their family may be present when the care worker arrives, they may have eaten before a visit intended to help them eat, they may not be at home or the visit is one of several during a day and thus there is not much to be done (see below for the full responses).

However, given the volume of short calls, and the frequent complaints of care workers, it is likely that crammed rotas are to blame for a large amount of the visits cut short too early. Inspections by the Care Quality Commission into home care branches often find this to be the case and it is a common finding in reports by NGOs and other concerned organisations, including Corporate Watch. Since we began speaking with home care workers two years ago almost all of them have made this complaint. The Care Quality Commission’s 2013 report on home care services for example, found that:

“The reasons for late and missed calls often related to care workers being rushed or not staying for the allocated length of time. We saw examples of staff rotas where shifts for the current week were not covered; some staff told us that it wasn’t unusual for them to be asked to cover an additional visit in their schedule for the day, which could mean that they had to cut short other visits. There were numerous examples of rotas that did not allow time for staff to travel between visits…”.⁶

Late visits

Of the councils that disclosed data, 26 said they could use their ECM systems to find details of late visits. However, three of these only recorded the total number of late visits. As these included visits that only start a few minutes late – and as such would not have had a significant impact on the quality of care provided – we have not included them here.

In the three month period from March to May 2016, these councils recorded 4.7m visits with their ECM systems.

Many councils only count late visits as those which begin over half an hour after the scheduled appointment time. The disclosed figures suggest around one in three home care visits are late to some degree, but those recorded as starting less than half an hour are not seen as particularly worrying by councils, or by the care workers or relatives of people cared for that we spoke to. Late visits at this level may be caused by the care worker logging into the system after they arrived at the clients’ home, unexpected traffic or a number of other such issues and are unlikely to have particularly severe repercussions on the standard of care provided.⁷

However the number of visits starting over half an hour late is also high. As the table below shows almost half a million – or one in ten visits – over the three month period started over 30 minutes late.

Many were even later: 185,000 started one hour late, while another 84,000 started an hour and a half late, and almost 50,000 started two hours late.

Just how often people are left waiting for support to wash, eat, dress or take medication depends on where they live. In Hounslow and the Wirral for example, around one in five visits started over half an hour late, while in South Gloucestershire just 3% did.

** Only record visits as over thirty minutes late

Those councils that replied to questions about the results said there could be many reasons why a visit may start later than expected, such as unusually heavy traffic, an earlier visit lasting longer than expected, an issue with a care worker’s phone preventing them from logging the call on time or one worker having to unexpectedly cover for the absence of another. Rotas may also be changed without the ECM schedule being updated, meaning visits look much later than they actually are.

However, as with short visits, rotas that do not give care workers enough time to travel from one call to the next seem the likely cause of many of the late visits.

Monitoring care or pay?

Care workers complain that ECM systems are used primarily to cut their wages. Their rotas often do not allow enough time to travel between visits and the ECM systems allow companies and the councils that contract them to catalogue exactly when calls start and finish and to adjust pay accordingly.⁸

Only a minority – 31 – of councils that use ECM were able to give us details of how many visits were either late or shorter than 15 minutes. Of those, only 20 were able to give details of both. The rest either said they were unable to retrieve this vital information around care quality from their own or their providers’ ECM systems, or they refused our request on cost grounds (see below).

Their inability to easily retrieve this information suggests many councils are not primarily using the ECM systems to monitor the care delivered but to monitor the time the staff spend in appointments – and reduce pay accordingly. As the London Borough of Hounslow told us:

“The primary aim of this system is not to monitor the punctuality of calls but to determine the amount of minutes that care was provided in order to reconcile our payments with what a provider has charged.”

These systems do allow the councils to log exactly how many minutes care workers spent in people’s homes, and to pay the companies that provide the care accordingly. So if an appointment scheduled for half an hour only lasts 20 minutes, the council will only pay for the 20 minutes. This appears to be the case for the majority of councils (all but three we spoke to said they only pay for “contact” time).

Consequently, care workers get paid less by the companies they work for. With a grim predictability, the system does not work the other way: care workers are not paid any extra if they spend more than the scheduled appointment time.

Full datasets available on request

* Corporate Watch contacted the 175 councils in England and Wales that organise home care provision. In addition to the 31 that disclosed the results above:

• 91 told us they do not use any ECM systems;⁹
• 14 said they did collect data through ECM systems but that the amount of time it would take to respond to our request would cost too much;¹⁰
• 30 said either they or their providers did use ECM systems but were unable to retrieve the relevant information from their systems;
• Eight disclosed information of total visits or hours but without records of late or short visits.
• One did not reply.

Hounslow, Havering, Waltham Forest, Staffordshire, Brent, Herefordshire, Bristol, Oldham, East Sussex, Oxfordshire, Lewisham, Lambeth and Blackburn councils responded to requests to explain the data. You can find their full answers here.